How USG has helped in early diagnosis & treatment in infertility
How USG has helpedin early diagnosis & treatment in infertility
Ultrasonongraphy (USG) is a useful and first line investigationused to assess the cause of infertility and to institute treatmentaccordingly. USG is an effective, safe, inexpensive, radiation free,non-invasive and readily available tool.
Role of ultrasound in female infertility
Ultrasound is used to evaluatethe pelvic organs (uterus and ovaries), growing ovarian follicles, and cyclicuterine endometrial changes.
Evaluation of uterus :
A) Structural anatomy - Using both 2D and 3D ultrasound congenitalmullerian anomalies can be diagnosed and classified according to ESHRE/ESGEclassification of uterine anomalies.
B) Pathologies:
1)Fibroid : seen in 5-10% of infertile women. Distortion of the endometrialcavity, abnormal endometrial receptivity, altered hormonal milieu, andendometrial development are the causative factors for infertility in fibroids.
USG providesthe number, exact location and sizeof fibroids, thus helps in thorough planningof surgical intervention if necessary.
2) Adenomyosis :Adenomyosis results in structural and functional defects of the uterinejunctional zone and thus resulting in disturbed uterine peristalsis and spermtransport, increased inflammatory response in the endometrium causing impairedimplantation. All these factors contribute to sub fertility and increased riskof miscarriage in Adenomyosis.
Theultrasonographic features of Adenomyosis are globularuterus, asymmetrical myohyperplasia, rain shower appearance andmyometrial cyst.
Endometrium :
Is a dynamicstructure undergoing cyclical changes. The endometrial pattern acts as anindirect measure of hormonal status during the cycle. Pathological featuressuch as thin endometrium, poor endometrial blood flow, presence of polyp orintrauterine adhesions can result in sub fertility. And all these pathologiesare accurately assessed using USG (both 2D + 3D).
Ovary :
USG is used for diagnosis and monitoring of treatment cycle in subfertile women.
1) Follicularmonitoring : Is an integral part of investigation in subfertilewomen. Serial scans during follicular phase evaluates the growth ofthe follicle, estimates the time of follicular rupture, the ideal time totrigger ovulation and occurrence of ovulation.
2) Antralfollicular count: Estimated on day 2 of menstrual cycle, follicles of 2- 8 mmsize measured and counted in each ovary. Diminished ovarian reserve diagnosedwhen AFC < 5. Early diagnosis of diminished ovarian reserve helps planningaccurate treatment such as IVF, thus reducing timeto pregnancy.
3) Endometrioticcysts : Endometriosis causes profoundinflammatory response in the pelvis, affecting oocyte quality, sperm transportand function, luteinized unruptured follicle, defective corpus luteum, alteredendometrial receptivity and also presence of adhesions results in subfertility. Presence of unilocular cyst with ground glass appearance of thecontents and peripheral blood flow are the USG features of endometriotic cyst.
4) Functional cysts: Thin walled, unilocular, anechoic cyst with minimal to absent blood flow.Functional cysts are unlikely to cause subfertility.
All these ultrasonographic features helps in early diagnosis andmanagement of female infertility.
Role of ultrasound in male infertility
Ultrasound of scrotum evaluates abnormalities within the testisand the peritesticular structures, such as varicocoeles and epididymalabnormalities. Thus aiding in identifying causative factor for male factorinfertility.
Transrectal ultrasound enables high-resolution imaging of theprostate, seminal vesicles and vas deferens and is the modality of choice indiagnosing congenital and acquired abnormalities implicated in the cause ofobstructive azoospermia (OA).
Penile ultrasound is used to evaluate physical causes of erectiledysfunction, including structural penile abnormalities, problems with arterialinflow and malfunction of the venous occlusive mechanism.
